Active NPI
Fagan ER Medical Group Inc
- Internal Medicine Physician
- Los Angeles, CA
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Internal Medicine Physician
- Legal business name
- FAGAN ER MEDICAL GROUP INC
- Practice address
- 1225 Wilshire Boulevard
Los Angeles, CA 90017-2395 - Phone
- (213) 482-2741
- NPI assigned
- Jul 13, 2006
- Last updated
- Dec 13, 2010
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Dr. Philip J. Fagan Jr., M.D.
- Title
- President
- Phone
- (818) 557-0135
Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | Primary |
Addresses
Primary practice location
1225 Wilshire Boulevard
Los Angeles, CA 90017-2395
Mailing address
520 N Central Ave
Suite 750
Glendale, CA 91203-1926
Phone (818) 557-0135
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| ZZZ43319Z | Other | CA | GOOD SAM BLUE SHIELD |
| GR0048650 | Medicaid | CA | |
| CC6682 | Other | CA | GOOD SAM RAILROAD |
National Provider Directory
National Provider DirectoryLocations
1055 W 7th St
Los Angeles, CA 90017
Phone (213) 593-6276
1212 E Avenue S
Palmdale, CA 93550
Phone (818) 841-0687
Practitioners & affiliated clinicians
Practitioners 1
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1152748800000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1292198400000",
"number": "1588689236",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "520 N CENTRAL AVE",
"address_2": "SUITE 750",
"city": "GLENDALE",
"state": "CA",
"postal_code": "912031926",
"telephone_number": "818-557-0135",
"fax_number": "818-557-1394"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1225 WILSHIRE BOULEVARD",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900172395",
"telephone_number": "213-482-2741"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "FAGAN ER MEDICAL GROUP INC",
"organizational_subpart": "NO",
"enumeration_date": "2006-07-13",
"last_updated": "2010-12-13",
"status": "A",
"authorized_official_last_name": "FAGAN",
"authorized_official_first_name": "PHILIP",
"authorized_official_middle_name": "J.",
"authorized_official_title_or_position": "PRESIDENT",
"authorized_official_telephone_number": "818-557-0135",
"authorized_official_name_prefix": "Dr.",
"authorized_official_name_suffix": "Jr.",
"authorized_official_credential": "M.D."
},
"taxonomies": [
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "GOOD SAM BLUE SHIELD",
"identifier": "ZZZ43319Z",
"state": "CA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "GR0048650",
"state": "CA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "GOOD SAM RAILROAD",
"identifier": "CC6682",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Los Angeles, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 13, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.